Why We Still Use “Organic Causes”: Results From a Survey of Psychiatrists and Residents

Benrimoh, David; Pomerleau, Vincent Jetté; Demoustier, Arnaud; Poulin, Stéphane; Maltais, Jean-Robert; Brouillette, Judith; Ducharme, Simon

doi:10.1176/appi.neuropsych.18050099

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…The copyright holder for this preprint this version posted March 29, 2023. ; https://doi.org/10.1101/2023.03.29.23287901 doi: medRxiv preprint Studying psychiatrists, Benrimoh et al (2018) surveyed 391 Canadian psychiatrists and psychiatric residents about their understanding and opinion concerning the term "organic causes". Just over half (55.9%) reported using the terminology but only 28.5% thought it was appropriate to use in their work and the qualitative answers revealed high levels of ambivalence about the terms and its potential negative effects and connotations but some resignation to its strategic benefits in securing better patient care.…”

Section: Despite Its Influence Clinicians Can Show Poor Agreement As ...mentioning

confidence: 99%

The meaning and role of the functional-organic distinction: a study of clinicians in psychiatry and neurology services

Chesterfield

Harvey

Hendrie³

et al. 2023

Preprint

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Aims: The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities, and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and the conditions to which they apply, as well as noting value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Method: Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semi-structured interviews that were analysed applying a constructivist grounded theory approach. Results: The distinction was described as often incongruent with how clinicians conceptualise patients' problems. Organic factors were considered to be objective, unambiguously identifiable, and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors - including cultural assumptions, service demands, patient needs, and colleagues' views - were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision-making required it to be used strategically. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. Conclusions: There is a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were central in deciding which to lean on.

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Section: Despite Its Influence Clinicians Can Show Poor Agreement As ...mentioning

confidence: 99%

The meaning and role of the functional-organic distinction: a study of clinicians in psychiatry and neurology services

Chesterfield

Harvey

Hendrie³

et al. 2023

Preprint

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show abstract

“…A survey of 391 Canadian psychiatrists and psychiatric residents by Benrimoh et al 45 asked respondents to give opinions on the use of the phrase “organic causes” in their clinical work, and in psychiatry more generally. Over half of respondents (55.9%) reported they used the phrase regularly.…”

Section: Inconsistent Use and Interpretation In Clinical Practicementioning

confidence: 99%

What is the functional/organic distinction actually doing in psychiatry and neurology?

et al. 2020

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The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms ‘functional’ and ‘organic’ varies considerably by context. Techniques for differentially diagnosing ‘functional’ and ‘organic’ diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of ‘zero sum’ causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note ‘functional’ and ‘organic’ have loaded social meanings, creating the potential for social disempowerment. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other in neuropsychiatric thinking. We also note that the contribution of people who experience the interaction between ‘functional’ and ‘organic’ factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

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“…A survey of 391 Canadian psychiatrists and psychiatric residents by Benrimoh et al (2018) asked respondents to give opinions on the use of the phrase "organic causes" in their clinical work, and in psychiatry more generally. Over half of respondents (55.9%) reported they used the phrase regularly.…”

Section: Selectionmentioning

confidence: 99%

What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology?

Bell¹,

Wilkinson²,

Greco³

et al. 2020

Preprint

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The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms 'functional' and 'organic' varies considerably by context. Techniques for differentially diagnosing 'functional' and 'organic' diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of 'zero sum' causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note 'functional' and 'organic' have loaded social meanings, creating the potential for social disempowerment and epistemic injustice. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other. We also note that the contribution of people who experience the interaction between 'functional' and 'organic' factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

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Why We Still Use “Organic Causes”: Results From a Survey of Psychiatrists and Residents

Cited by 10 publications

References 17 publications

The meaning and role of the functional-organic distinction: a study of clinicians in psychiatry and neurology services

The meaning and role of the functional-organic distinction: a study of clinicians in psychiatry and neurology services

What is the functional/organic distinction actually doing in psychiatry and neurology?

What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology?

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